{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TINA L BLEVINS","gend":1,"add":"PO Box 15","city":"Whitetop","state":"VA","zip":"24292-0015","dob":"1963-09-04","age":"","mstatus":"","insh":"11004310","cliId":"","pno":2763883704,"cno":2767688896,"email":"","ename":"","eno":"","pphy":"MCQUEEN, KELLY","ppno":4232243950,"pcpadd":"4600 Fort Henry Dr","pcpcity":"Kingsport","pcpstate":"TN","pcpzip":376632617,"pcpcounty":"","pcpid":"","pcpname":"KONNAROCK FAMILY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO Box 15","madd2":"","madd3":"","mcity":"Whitetop","mstate":"VA","mzip":"24292-0015","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00093100305","BUSPIRONE ","15MG","90.00","Select","Select",""],["","16714068403","SIMVASTATIN ","40MG","30.00","Select","Select",""],["","50111091701","TORSEMIDE ","20MG","30.00","Select","Select",""],["","00093762598","PREGABALIN ","100MG","60.00","Select","Select",""],["","16714073902","FENOFIBRATE ","67MG","30.00","Select","Select",""],["","16714045701","QUETIAPINE ","400MG","30.00","Select","Select",""],["","13668001005","CITALOPRAM ","20MG","30.00","Select","Select",""],["","16714085201","METOPROL ","25MG ER","30.00","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","30.00","Select","Select",""],["","50228042360","RANOLAZINE ","500MG ER","60.00","Select","Select",""],["","00406802003","BUPREN\/NALOX ","8-2MG","90.00","Select","Select",""],["","00115167102","HYDROXYZ ","50MG","90.00","Select","Select",""],["","68462017901","NAPROXEN ","550MG","20.00","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","90.00","Select","Select",""],["","69315011610","FUROSEMIDE ","20MG","30.00","Select","Select",""],["","61958100301","RANEXA ","500MG","60.00","Select","Select",""],["","65162025311","RANITIDINE ","150MG","180.00","Select","Select",""],["","10572010001","PEG-3350 ","ELECTROL","4,000.00","Select","Select",""],["","68180051703","LISINOPRIL ","40MG","30.00","Select","Select",""],["","68462063945","NITROGLYCERN ","0.4MG","25.00","Select","Select",""],["","00781107810","ATENOLOL ","25MG","30.00","Select","Select",""],["","00378104901","DOXEPIN ","10MG","30.00","Select","Select",""],["","00228300411","CLONAZEPAM ","1MG","60.00","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","90.00","Select","Select",""],["","00054001829","PREDNISONE ","20MG","15.00","Select","Select",""],["","00071101668","LYRICA ","150MG","60.00","Select","Select",""],["","31722053401","METHOCARBAM ","750MG","30.00","Select","Select",""],["","57237002901","AMOXICILLIN ","875MG","20.00","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","20.00","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}